Assessing corneal biomechanics in vivo has long been a challenge in the field of ophthalmology. Although recent wave-based optical coherence elastography (OCE) methods have shown promise in this area, the effect of intraocular pressure (IOP) on mechanical wave propagation in the cornea remains unclear. To address this, we constructed an artificial eye model and performed surface wave OCE measurements in the radial directions (54–324°) of the silicone cornea at varying IOP levels (10–40 mmHg). The results demonstrated increases in wave propagation speeds (mean ± STD) from 6.55 ± 0.09 m/s (10 mmHg) to 9.82 ± 0.19 m/s (40 mmHg), leading to an estimate of Young’s modulus, which increased exponentially from 145.23 ± 4.43 kPa to 326.44 ± 13.30 kPa. Our implementation of an artificial eye model highlighted that the impact of IOP on Young’s modulus (ΔE = 165.59 kPa, IOP: 10–40 mmHg) was more significant than the effect of stretching of the silicone cornea (ΔE = 15.79 kPa, relative elongation: 0.98%–6.49%). Our study sheds light on the potential of using an artificial eye model in OCE research for corneal biomechanics. Furthermore, it is critical to consider the impact of IOP on measurement results when utilizing wave-based OCE in clinical settings for enhanced assessment of corneal biomechanics.

Glucosamine is the most common nutrition supplement used in the United States. It is promoted not only as a pain reliever but also a therapy to slow osteoarthritis. Although studies with 3,800 patients with osteoarthritis of the knee or hip found that glucosamine was no better than placebo, it continues to be used for these two indications due to its perceived safety. However, reports of an increased intraocular pressure are alarming, especially in glaucoma. Glycosaminoglycans play a key role in the physiology of the cornea, conventional outflow of aqueous humor and the retina. In theory, long-term treatment with glucosamine could reach a concentration that impacts the morphology and function of ocular tissues. We recommend ophthalmologists counsel glaucoma patients about the potential risks of glucosamine and encourage cessation in uncontrolled intraocular pressure.

Purpose: The evaluation of the efficacy of topical hypotensive treatment and/or systemic corticosteroids therapy in patients with elevated intraocular pressure and Graves’ orbitopathy (GO). Methods: 172 eyes in 86 individuals with duration of GO ≥ 3 months, intraocular pressure in either eye ≥ 25.0 mmHg and GO ranked ≥ 3 at least in one eye in modified CAS form, were included. The study subjects were divided into three treatment subgroups: subgroup I was administered latanoprost QD; subgroup II was administered a combined preparation of brimonidine and timolol BID; subgroup III was the control group, not receiving any topical hypotensive treatment. All the study participants received systemic treatment – intravenous corticosteroid therapy at the same dose, according to the EUGOGO guideline Results: On the final visit, the mean IOP value was significantly lower in all treatment subgroups comparing to the initial values. In both subgroups receiving topical treatment the IOP reduction was higher than in the control group receiving systemic corticosteroids only. However, the latanoprost eye drops decreased intraocular pressure more effectively than drops containing brimonidine and timolol. Conclusion: Topical ocular hypotensive treatment is effective in reducing intraocular pressure in GO and decreases intraocular pressure more effectively than systemic corticosteroid therapy alone.

Purpose: To investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype. Methods: Eight eyes of a porcine pigmentary glaucoma model underwent 90° of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, an additional 90° of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&E) was obtained. Results: After the first 90° TM excision, IOP was significantly lower in G (10.23±2.39 mmHg, n=7) than C (20.04±1.97mmHg, n=8, P<0.01). Outflow facility in G (0.38±0.07 µl/min/mmHg) was higher than C (0.16±0.02 µl/min/mmHg, P<0.01). After the second 90° TM excision, IOP in G (6.46±0.81 mmHg, n=7) was significantly lower than C (20.25±1.66 mmHg, n=8, P<0.001), while the outflow facility in G (0.50±0.05 µl/min/mmHg, n=7) was higher than C (0.16±0.01 µl/min/mmHg, n=8, P<0.001). Compared to the first excision, excision of an additional 90° did not change of IOP (P=0.20) or outflow facility (P=0.17) further. Conclusion: Excision of 90° of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility. Translational Relevance: Microsurgical TM excision over 90° can effectively restore outflow in pigmentary glaucoma.

Dysfunction and selective loss of retinal ganglion cells (RGCs) is a known cause of vision loss in glaucoma and other neuropathies where ocular hypertension (OHT) is the major risk factor. We investigated the impact of transient non-ischemic OHT spikes (spOHT) on RGC function and viability in vivo to identify cellular pathways linking low-grade repetitive mechanical stress to RGC pathology. We found that repetitive spOHT had an unexpectedly high impact on intraocular homeostasis and RGC viability, while exposure to steady OHT (stOHT) of similar intensity and duration failed to induce pathology. The repetitive spOHT induced a rapid activation of the inflammasome, marked by the upregulation of NLRP1, NLRP3, AIM2, caspases -1, -3/7, -8, gasdermin D (GsdmD) and the release of interleukin-1β (IL-1β) and other cytokines into the vitreous. Similar effects were also detected after 5 weeks of exposure to chronic OHT in an induced glaucoma model. The onset of these immune responses in both spOHT and glaucoma models preceded a 50% deficit in pattern electroretinograms (PERG) amplitude, and significant loss of RGCs at 7 days post-injury. Inactivation of inflammasome complexes in NLRP1-/- , Casp1-/- and GsdmD-/- knockout animals, significantly suppressed the spOHT induced inflammatory response and protected RGCs. Our results demonstrate that mechanical stress produced by acute repetitive spOHT or chronic OHT is mechanistically linked to inflammasome activation, which leads to RGC dysfunction and death.

Purpose: To evaluate clinical outcomes after bilateral mix-and-match cataract surgery using extended depth of focus (EDOF) and diffractive multifocal (DMF) intraocular lenses (IOLs). Methods: Thirty-seven patients received Tecnis Symfony EDOF IOL (ZXR00) implantation in the dominant eye, and Tecnis +3.25 DMF IOL (ZLB00) in the non-dominant eye. Patients were followed for 3 months, and uncorrected and corrected distance visual acuity (UDVA, CDVA) , uncorrected intermediate and near visual acuity (UIVA, UNVA), contrast sensitivity, defocus curves, stereopsis, and patient satisfaction were assessed. Results: At 3 months, mean logMAR UDVA was 0.07 ± 0.09 in EDOF IOL eyes, 0.12 ± 0.11 in DMF IOL eyes, and 0.02 ± 0.05 in both eyes. UIVA was 0.11 ± 0.11 in EDOF IOL eyes, 0.16 ± 0.12 in DMF IOL eyes, and 0.04 ± 0.07 in both eyes. UNVA was 0.25 ± 0.15 in EDOF IOL eyes, 0.22 ± 0.16 in DMF IOL eyes, and 0.13 ± 0.13 in both eyes. Thirty patients(81.1%) were more than satisfied with near vision, and 8 patients(21.6%) complained of severe glare and halo. Spectacle independence for near vision was achieved in 34 patients(91.9%), and 31 patients(83.8%) had better than a 50 second arc of stereopsis. Conclusion: Mix-and-match cataract surgery with EDOF and DMF IOL implantation provided good visual outcomes through all distances. Also excellent patient satisfaction was achieved with high level of spectacle independence and minimal photic phenomena.

To compare surgical and refractive outcomes between phacotrabeculectomy (P-Trab) and phaco with Ex-PRESS (P-Ex-PRESS) for glaucoma at 6-month follow-up. This prospective randomized controlled trial included 81 eyes; 43 (53%) and 38 (47%) were assigned to the P-Ex-PRESS and P-Trab groups, respectively. Refraction, intraocular pressure (IOP), and best-corrected visual acuity were measured. Refractive change was described by analyzing the magnitude of the cylinder, and polar analysis assessed the change in trend of astigmatism [with-the-rule, against-the-rule (ATR), oblique] evaluating mean astigmatism in centroid form. All patients showed statistically significant postsurgical decrease in IOP (P&lt;0.05). There were no differences neither between the groups for postoperative IOP or visual outcomes, nor in astigmatism before or after surgery (P=0.61, P=0.74). In both groups, the mean pre- and postoperative astigmatism was ATR and OBL, respectively. Pre- and postoperative centroids in the P-Ex-PRESS group were 0.44±1.32 D at 177˚ and 0.35±1 D at 8˚, respectively, (P=0.5) and in the P-Trab group, 0.16±1.5 D at 141˚ and 0.39±1.38 D at 29˚, respectively (P=0.38). Both P-Ex-PRESS and P-Trab showed comparable antihypertensive efficacy in treating open-angle glaucoma in a 6-month period. Pre- and postoperative astigmatism did not differ between groups. The groups showed comparable results for final visual acuity.

Purpose: To compare ab interno trabeculectomy by trabecular meshwork excision to plasma-mediated ablation in primary open-angle glaucoma. Methods: Retrospectively collected data of TrabEx+ (TEx, n=56) and Trabectome (T, n=99) were compared by coarsened exact matching to reduce confounding and matched based on baseline IOP and age. Primary outcomes were IOP and number of glaucoma medications. Complications and need for additional glaucoma surgery were assessed. Patients were followed for up to one year. Results: 53 TEx could be matched to T. Baseline IOP was 16.5±4.6 mmHg in both; age was 73.7±8.8 and 71.5±9.9 years in TEx and T, respectively. TEx were taking more medications than T (p<0.001). IOP was reduced to 14.8±4.3 in TEx and to 13.4±3.4 in T at 6 months, and to 14.9±6.0 (p=0.13) in TEx and to 14.1±3.8 mmHg (all p<0.05) in T at 12 months. Medications were reduced at both 6 and 12 months (p< 0.05). No differences were seen between TEx and T at 6 and 12 months. In TEx, only one serious complication occurred, and two patients required further glaucoma surgery. Conclusion: Although both groups had a baseline IOP considered low for ab-interno trabeculectomy, IOP and medications were reduced further at 6 and 12 months. IOP reduction did not reach significance in TEx at 12 months. The inter-group comparison did not reveal any significant differences. Both had a low complication rate.

Purpose: To determine whether 24-hour IOP monitoring can be a predictor for glaucoma progression and to analyze the inter-eye relationship of IOP, perfusion and progression parameters. Methods: We extracted data from manually drawn IOP curves with HIOP-Reader, a software suite we developed. The relationship between measured IOPs and mean ocular perfusion pressures (MOPP) to retinal nerve fiber layer (RNFL) thickness was analyzed. We determined the ROC curves for peak IOP (Tmax), average IOP (Tavg), IOP variation (IOPvar) and historical IOP cut-off levels to detect glaucoma progression (rate of RNFL loss). Bivariate analysis was conducted to check for various inter-eye relationships. Results: 217 eyes were included. The average IOP was 14.8±3.5 mmHg, with a 24-hour variation of 5.2±2.9 mmHg. 52% of eyes with RNFL data showed disease progression. There was no significant difference in Tmax, Tavg and IOPvar between progressors and non-progressors (all p>0.05). Except for Tavg and the temporal RNFL, there was no correlation between disease progression in any quadrant, Tmax, Tavg and IOPvar. 24-hour and outpatient IOP variables had poor sensitivities and specificities in detecting disease progression. The correlation of inter-eye parameters was moderate; correlation with disease progression was weak. Conclusion: In line with our previous study, IOP data obtained during a single visit (outpatient or inpatient monitoring) make for a poor diagnostic tool, no matter the method deployed. Glaucoma progression and perfusion pressure in left and right eyes correlated weakly to moderately with each other.

Purpose: Nycthemeral (24-hour) glaucoma inpatient intraocular pressure (IOP) monitoring has been used in Europe for more than 100 years to detect peaks missed during regular office hours. Data supporting this practice is lacking, partially because it is difficult to correlate manually drawn IOP curves to objective glaucoma progression. To address this, we deployed automated IOP data extraction tools and tested for a correlation to a progressive retinal nerve fiber layer loss on spectral-domain optical coherence tomography (SDOCT). Methods: We created and deployed a machine-learning image analysis software to extract IOP data from hand-drawn, nycthemeral IOP curves of 225 retrospectively identified glaucoma patients. The relationship between demographic parameters, IOP and mean ocular perfusion pressure (MOPP) data to SDOCT data was analyzed. Sensitivities and specificities for the historical cut-off values of 15 mmHg and 22 mmHg in detecting glaucoma progression were calculated. Results: IOP data could be extracted efficiently. The IOP average was 15.2±4.0 mmHg, nycthemeral IOP variation was 6.9±4.2 mmHg, and MOPP was 59.1±8.9 mmHg. Peak IOP occurred at 10 AM and trough at 9 PM. Disease progression occurred mainly in the temporal-superior and -inferior SDOCT sectors. No correlation could be established between demographic, IOP, or MOPP parameters and SDOCT disease progression. The sensitivity and specificity of both cut-off points (15 and 22 mmHg) were insufficient to be clinically useful. Outpatient IOPs were non-inferior to nycthemeral IOPs. Conclusion: IOP data obtained during a single visit make for a poor diagnostic tool, no matter whether obtained using nycthemeral measurements or during outpatient hours.

Background: Nowadays, the prevalence of digital device usage has shifted the demands for multifocal intraocular lenses. To accurately capture outcomes, clinical practice must evaluate digital reading performance. We aimed to assess the digital reading performance using a digital device in patients with diffractive multifocal intraocular lenses. Methods: Patients with bilateral diffractive multifocal intraocular lens implantation were included in the study. Monocular and binocular uncorrected and corrected visual acuity was measured using the LogMAR chart and the MNREAD application. Binocular uncorrected defocus curves were obtained using the LogMAR chart at 4m. The reading acuity was measured using the MNREAD application with positive and negative display polarities. The mean digital critical print size (CPS) was recorded using the MNREAD application at 40cm. Results: Our study reported uncorrected distance, intermediate, and near visual acuity were -0.084 ± 0.079, -0.014 ± 0.078, and 0.040 ± 0.081, respectively. The mean reading acuity at three months postoperatively with positive display polarity at 60cm and 40cm was -0.115 ± 0.102 and -0.008 ± 0.083, respectively. The mean digital CPS at three months postoperatively was 0.238 ± 0.100 logMAR. Conclusions: Incorporating digital reading performance measurements provides additional advantages in assessing the effectiveness of bilateral diffractive multifocal intraocular lens implantation.

Aim: Reporting 3 year outcomes of a community shared care scheme run by specialised independent prescribing (IP) optometrists for stable glaucoma and ocular hypertension (OHT) patients in West Kent, England. Purpose: Shared Care Schemes for glaucoma exist to alleviate the burden on Hospital Eye Services (HES) glaucoma clinics. We studied the effectiveness of community care by highly trained and qualified IP optometrists in terms of disease stability and referral rate into HES.Methods: Retrospective longitudinal review of 200 eyes with stable early to moderate stage glaucoma and OHT followed-up in two specialist optometry practices. Outcome measures included visual field mean deviation (VFMD), intraocular pressure (IOP), changes to treatment and referral rate into HES. Inclusion criteria included all patients with OHT and glaucoma (open angle and primary angle closure) referred for community follow-up. Incomplete data sets were excluded.Results: Mean age 71yrs (range 28 - 93yrs) and equal male: female ratio. n= 159 at year 3. The results for both outcomes showed no significant change from baseline at 12 or 24-month time points. However, a significant change from baseline at 36 months was observed for both outcomes: mean reduction of 0.7 mmHg in IOP, and a mean reduction of 0.3 dB in VFMD. There was a statistically significant change in the number of drops used at 36 months (p=0.001). 11 patients had a change in medication within 3 years. One patient was referred back to HES for uncontrolled IOP and consideration of trabeculectomy.Conclusion: Community follow-up of stable cases of glaucoma and OHT by highly qualified IP optometrists was safe, with stability of disease maintained and few referrals back to HES.

Purpose: To evaluate three different microincisional ab interno trabeculectomy procedures in a porcine eye perfusion model. Methods: In perfused porcine anterior segments, 90 degrees of trabecular meshwork (TM) were ablated using the Trabectome (T; n = 8), Goniotome (G; n = 8), or Kahook device (K; n = 8). After 24 hours, additional 90 degrees of TM were removed. Intraocular pressure (IOP) and outflow facility were measured at 5 µL/min and 10 µL/min perfusion to simulate an elevated IOP. Structure and function were assessed with canalograms and histology. Results: At 5 µL/min infusion rate, T resulted in a greater IOP reduction than G or K from baseline (76.12% decrease versus 48.19% and 47.96%, P = 0.013). IOP reduction between G and K was similar (P = 0.420). Removing another 90 degrees of TM caused an additional IOP reduction only in T and G but not in K. Similarly, T resulted in the largest increase in outflow facility at 5 µL/min compared with G and K (first ablation: 3.41 times increase versus 1.95 and 1.87; second ablation: 4.60 versus 2.50 and 1.74) with similar results at 10 µL/min (first ablation: 3.28 versus 2.29 and 1.90 (P = 0.001); second ablation: 4.10 versus 3.01 and 2.01 (P = 0.001)). Canalograms indicated circumferential flow beyond the ablation endpoints. Conclusions: T, G and K significantly increased the outflow facility. In this model, T had a larger effect than G and K.

This study aimed to compare the efficacies and safety of enhanced and standard monofocal intraocular lenses (IOLs) in eyes with early glaucoma. Patients with concurrent cataracts and open-angle glaucoma (OAG) were enrolled. They underwent cataract surgery with IOL implantation. Manifest refraction; monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA); visual field (VF); contrast sensitivity (CS); defocus curves and questionnaires were assessed three months postoperatively. Thirty-four and 38 patients had enhanced and standard monofocal IOLs, respectively. The enhanced monofocal IOL provided better UIVA than the standard monofocal IOL (p = 0.003) but similar UDVA, CDVA and UNVA. The enhanced monofocal IOL had more consistent defocus curves than the standard monofocal IOL, especially at -1 (p = 0.042) and -1.5 (p = 0.026) diopters. The enhanced monofocal IOL provided better satisfaction (p = 0.019) and lower spectacle dependence (p = 0.004) than the standard monofocal IOL for intermediate vision, with similar VF and CS. In conclusion, the enhanced monofocal IOL is recommended for patients with OAG because they provide better intermediate vision, higher satisfaction, and lower dependence on spectacles than standard monofocal IOL, without worsening other visual outcomes.

Glaucoma is a disease associated with retina of eye. Presently, millions of human being is suffering from this disease. Early detection of these diseases can save the people from blindness. Therefore, various methods have been developed for its detection. In this paper, we have studied the reported methods and summarized their performance in terms of accuracy of detection.

Progressive loss of retinal ganglionic cells (RGC) causes blindness in glaucoma. Elevated intraocular pressure (IOP) is the most important, treatable risk factor. Currently, the management of glaucoma is centred at reducing the IOP, and drugs in the form of topical drops are the first line of management. Drugs reduce IOP either by suppressing aqueous humour secretion or improving the aqueous humour outflow. Newer drugs added during the past three decades to the armamentarium of glaucoma treatment have targeted the aqueous outflow. With an evolving understanding of the pathogenesis of glaucoma, the role of 24-hour IOP control and other IOP-independent risk factors affecting ocular blood flow and RGC toxicity is also recognised. The role of available drugs in controlling IOP over 24-hours is being evaluated. Improvement of ocular blood flow and neuroprotection are seen as potential drug targets in preventing the loss of RGC. In this article, we review the pharmacotherapy of glaucoma based on current therapeutic principles.

Imaging of the ocular vasculature can provide new insights into the pathophysiology of ocular diseases. This study proposes a novel high-frequency super-resolution ultrasound localization microscopy (SRULM) technique and evaluates its ability to measure in vivo perfusion changes in the rat eye at elevated intraocular pressure (IOP). A 38.4 MHz center frequency linear array transducer on a VisualSonics Vevo F2 imaging platform was used to collect high frame rate (1 kHz) radiofrequency data of the posterior rat eye following systemic microbubble contrast injection. Following clutter and spatiotemporal non-local means filtering, individual microbubbles were localized and tracked. The microbubble tracks were accumulated over 10,000 frames to generate vascular images quantifying perfusion velocity and direction. Experiments were performed using physiologic relevant controlled flow states for algorithm validation and subsequently performed in vivo on the rat eye at 10 mm Hg IOP increments from 10 to 60 mm Hg. The posterior vasculature of the rat eye, including the ophthalmic artery, long posterior ciliary arteries and their branches, central retinal artery and retinal arterioles and venules were successfully visualized, and velocities quantified at each IOP level. Significant reductions in arterial flow were measured as IOP was elevated. High-frequency SRULM can be used to visualize and quantify perfusion velocity of the rat eye in both the retrobulbar and intraocular vasculature simultaneously. The ability to detect ocular perfusion changes throughout the depth of the eye may help elucidate the role ischemia has in the pathophysiology of ocular diseases such as glaucoma.

Purpose: To improve numerical simulation of the non-contact tonometry test by using Arbitrary Eulerian-Lagrangian deforming mesh in the coupling between computational fluid dynamics model of an air jet and finite element model of the human eye. Methods: Computational fluid dynamics model simulated impingement of the air puff and consisted of 25920 wedge6 elements and employed Spallart-Allmaras model to simulate capture turbulence of the air jet. The time span of the jet wais 30 ms and maximum Reynolds number

The widespread use of hydrophilic intraocular lenses (IOL) in eye surgery, fabricated by poly-2- (hydroxyethylmethacrylic acid) (PHEMA), has highlighted their calcification as a serious problem, which implies their surgical explantation a rather risky process. The field of biomaterials has been developing rapidly in recent years with research interest turning to the development of novel ma-terials which involve either copolymers of PHEMA or protective functional coatings. Graphene coatings are particularly attractive because of the respective unique properties. In the present work we present the results of the investigation of the development of graphene coatings on hydrophilic IOLs and their subsequent performance with respect to calcification opacification. Hydrophilic IOL with water content of 18% by weight, were coated with graphene oxide (GO) by equilibration with GO suspensions in water. The concentrations of the suspensions ranged 1x10-4 to 20x10-4 % w/v. The GO suspensions were equilibrated with the IOLs for 5 days at constant temperature, 37°C, rotated in 30 mL tubes end over end. This treatment, resulted in the formation of a uniform coating of GO on the IOLs verified by scanning electron microscopy (SEM) and other physicochemical methods. The contact angle of the GO coated IOLs decreased significantly in comparison with the uncoated. The GO-coated IOLs exhibited higher tendency to calcify in supersaturated solutions simulating aqueous humor (SAH). The growth rate of hydroxyapatite (Ca5(PO4)3OH, HAP) on GO-coated IOLs was higher, in comparison with the respective untreated IOLs. The conversion of the GO coating by reduction with phenyl hydrazine resulted in the formation of reduced graphene (rGO) surface film, identified by Raman and XPS spectroscopy. of the rGO film was hydrophobic (contact angle 100 o) and did not calcify in supersaturated calcium phosphate solutions.

Pigment dispersion can lead to pigmentary glaucoma, a poorly understood condition of younger myopic eyes with fluctuating high intraocular pressure. It has been difficult to investigate its pathogenesis without a model similar to human eyes in size and behavior. Here we present a porcine ex vivo model that recreates several features of pigmentary glaucoma, including intraocular hypertension, accumulation of pigment in the trabecular meshwork, and declining phagocytosis. We found that trabecular meshwork cells regulate outflow, form actin stress fibers, and have a decreased phagocytic activity. Gene expression microarrays and a pathway analysis of TM monolayers as well as ex vivo anterior segment perfusion cultures indicated that RhoA plays a central role in regulating the cytoskeleton, motility, and phagocytosis in the trabecular meshwork, providing new insights and targets to investigate in pigmentary glaucoma.

To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open-angle glaucoma (POAG) patients. This was a multicenter, retrospective study and included POAG patients with or without visually-significant cataracts. The primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2-years. Success was defined as: 1) IOP < 21 mmHg and at least 20% IOP reduction from baseline after 3 months at any two consecutive visits, and 2) no additional glaucoma surgery required. A total of 42 patients were enrolled; thirteen had a history of failed glaucoma surgery. Twelve patients underwent Trabectome surgery combined with phacoemulsification while the remainder underwent Trabectome surgery alone. Overall, the mean preoperative IOP was 21.4±1.23 mmHg. The Trabectome lowered IOP to 18.5± 0.94 mmHg at 2 years (P<0.05). The number of glaucoma medications also decreased from a baseline of 2.0±0.9 to 1.2± 0.21 at 2 years (P=0.04). The overall success was 78%, with patients undergoing combined surgery having a higher success than those with Trabectome surgery alone (100% vs. 76%). No major complications were seen. The Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.

: Glaucoma is the most common cause of blindness, which significantly reduces quality of life. Most glaucoma cases are primary glaucoma; nevertheless, many patients suffer from glaucoma caused by drugs, such as corticosteroids. A comprehensive review of the risks associated with corticosteroid-induced glaucoma is limited. Therefore, we used the Japanese Adverse Drug Event Reporting Database (JADER) published by the Pharmaceuticals and Medical Devices Agency (PMDA) to analyze the risk factors associated with glaucoma and the trends and characteristics of corticosteroid-induced glaucoma. We did not find sex or age differences associated with the onset of glaucoma. Hierarchical clustering and principal component analysis revealed that triamcinolone acetonide and betamethasone sodium phosphate, which are used around the eyes in Japan, are more likely to induce intraocular pressure (IOP) elevation compared with other corticosteroids. Increased IOP is a direct cause of glaucoma. Based on these findings, it may be necessary to limit or avoid the use of these corticosteroids.